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ANGKOR PHARMACY
CH090780 Community Medical Centers, Inc.
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Covered Entity Details
Entity Name
Community Medical Centers, Inc.
Subdivision Name
Community Medical Centers, Channel
Type
HRSA-Funded Health Center
340B ID
CH090780
Entity Address
701 E Channel St.
Stockton, CA 95202-2628
Grant Number
H80CS00138
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
ANGKOR PHARMACY
Pharmacy Address
4555 N PERSHING AVE STE 7
STOCKTON, CA 95207-6739
Pharmacy Comments
Contract Details
Approval Date
4/12/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/19/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Christine Noguera, CEO
(209) 373-2826
Contract Pharmacy Representative
Bunnaun Uch, Owner
(209) 473-4706
Signed By Date
4/12/2016
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